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Intravitreal triamcinolone acetonide compared with bevacizumab for the treatment of patients with macular edema secondary to central retinal vein occlusion

Gokcen Gokce, Gungor Sobaci, Ali Hakan Durukan, Fazil Cuneyt Erdurman
Postgraduate Medicine 2013, 125 (5): 51-8
24113663

PURPOSE: To compare 12-month outcomes achieved using intravitreal triamcinolone acetonide (IVTA) injections with those achieved using intravitreal bevacizumab (IVB) injections for the treatment of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO).

MATERIALS AND METHODS: Between 2007 and 2011, 17 patient eyes were administered IVTA (4 mg/0.1 mL) and 30 patient eyes were administered IVB (1.25 mg/0.05 mL) injections for the treatment of ME secondary to CRVO. Patients were retrospectively evaluated within and between treatment groups.

RESULTS: Patients in both groups (IVTA and IVB) were similar in terms of demographic characteristics. Improvements in log of the minimum angle of resolution¯visual acuity (logMAR-VA) at 3-month follow-up (P = 0.02), and in the logarithmic transformation of optical coherence tomography (OCT)-determined central subfoveal thickness (logOCT) at all visits, were significantly greater in the IVTA-treated group than in the group treated with IVB (P < 0.05). In patient eyes with nonischemic CRVO (n = 21), while no significant difference in improvement in logMAR-VA was seen between the groups, significantly greater improvements in logOCT were observed in the IVTA-treated group for all visits (P < 0.05). In patient eyes with ischemic CRVO (n = 26) treated with IVTA (n = 9), improvement in logMAR-VA was significantly greater at months 1 and 3 (P = 0.01), and was significantly greater for logOCT at months 6 and 12 (P < 0.05). A significantly higher percentage (29.4%) of eyes treated with IVTA had an intraocular pressure ≥ 30 mm Hg (P = 0.004), 2 eyes (11%) developed glaucoma, and 23.5% of eyes developed cataracts at the 12-month follow-up examination (P = 0.05).

CONCLUSION: Treatment with IVTA injections seems to be more effective in improving best-corrected visual acuity during the early postinjection period in patients with ischemic CRVO, and in decreasing central subfoveal thickness in patients with nonischemic CRVO. However, higher intraocular pressure and development of glaucoma and cataracts must be considered seriously in patients with CRVO who receive IVTA injections. Change in logOCT may be used to monitor patient response to treatments for CRVO-related ME.

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